Huang Yueqi, Yang Hangyi, Zhu Cheng, Jiang Xiaoying, Zhu Wenjing, Liang Yan, Ma Lisha, Wang Yunzan, Tang Wenxin
Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China.
Fourth Clinical School, Zhejiang Chinese Medical University, Hangzhou 310013, China.
Brain Sci. 2022 Sep 28;12(10):1309. doi: 10.3390/brainsci12101309.
To explore whether a systematic combined therapeutic modality (CTM) could quickly and effectively improve the severity of obsessive-compulsive disorder (OCD) and the insight of OCD patients.
Included in this study were 100 patients with OCD according to the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a 2-week short-term treatment. They were assigned to a drug-alone group ( = 57), and a CTM group ( = 43) using drug treatment in combination with cognitive behavioral treatment (CBT) and repetitive transcranial magnetic stimulation (rTMS). The therapeutic outcome was assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Brown Assessment of Beliefs Scale (BABS), 24-item Hamilton Depression Scale (HAMD-24) and Hamilton Anxiety Scale (HAMA) before and after treatment. All data were treated with SPSS25.0 Software.
After the 2-week treatment, the success rate in the CTM group was significantly higher than that in the drug-alone group. Y-BOCS overall and factor scores were decreased as compared with those before treatment in both groups. HAMD, HAMA and BABS overall scores were all decreased after treatment in the CTM group. In addition, compared with the drug-alone group, the Y-BOCS overall score and factor score, HAMD overall score and HAMA overall score were all decreased significantly in CTM group, while the Y-BOCS score reduction rate was increased significantly. Insight was improved in eight cases (57.14%) in the CTM group containing 14 cases with poor insight. Multinomial logistic regression analysis showed that CTM was beneficial for the insight improvement of OCD patients (OR = 91.04-139.68); this improvement was more pronounced in patients with low baseline BABS overall scores (OR = 0.07).
CTM may be an effective short-term strategy to improve the severity of OCD and insight of OCD patients and, therefore, is worthy of clinical promotion and application.
探讨系统联合治疗模式（CTM）能否快速有效地改善强迫症（OCD）的严重程度及OCD患者的自知力。
根据《精神疾病诊断与统计手册》第5版（DSM-5）纳入100例OCD患者进行为期2周的短期治疗。将他们分为单纯药物治疗组（n = 57）和采用药物治疗联合认知行为治疗（CBT）及重复经颅磁刺激（rTMS）的CTM组（n = 43）。治疗前后采用耶鲁-布朗强迫症量表（Y-BOCS）、布朗信念评估量表（BABS）、24项汉密尔顿抑郁量表（HAMD-24）和汉密尔顿焦虑量表（HAMA）评估治疗效果。所有数据用SPSS25.0软件处理。
2周治疗后，CTM组的有效率显著高于单纯药物治疗组。两组Y-BOCS总分及因子分均较治疗前降低。CTM组治疗后HAMD、HAMA及BABS总分均降低。此外，与单纯药物治疗组相比，CTM组Y-BOCS总分及因子分、HAMD总分及HAMA总分均显著降低，且Y-BOCS评分降低率显著提高。CTM组14例自知力差的患者中有8例（57.14%）自知力得到改善。多项logistic回归分析显示，CTM有利于OCD患者自知力的改善（OR = 91.04 - 139.68）；在基线BABS总分较低的患者中这种改善更明显（OR = 0.07）。
CTM可能是改善OCD严重程度及OCD患者自知力的一种有效的短期策略，因此值得临床推广应用。
